| NPI | 1982830543 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: TX 28946) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA N/A) |
| Enumeration Date | 2009-06-09 |
| Last Update Date | 2013-06-17 |